As detailed by Vox's Julia Belluz, we have a reasonably clear picture of what our most likely causes of death were back in 1900, as compared to what they were in 2010. And, as you might expect, age appears to be playing a big role — conditions that worsen over time and most commonly afflict older people, like cancers, heart disease and Alzheimer's, have risen to greater prominence as our lifespans have stretched out.

Nowadays, while still deadly — especially for the very young, very old, or those with weakened immune systems — pneumonia has been relegated to the back of the list, distantly behind the top two killers, heart disease and cancer.

Making the right medical choices is harder than ever. Whether we're deciding to take a cholesterol drug or choosing a cancer treatment, we are overwhelmed by information from all sides: our doctors' recommendations, dissenting expert opinions, confusing statistics, conflicting media reports, the advice of friends, claims on the Internet, and a never ending stream of drug company ads. Your Medical Mind shows us how to chart a clear path through this sea of confusion. Drs. Groopman and Hartzband reveal that each of us has a set of deeply rooted beliefs whose profound influence we may not realize when we make medical decisions. How much trust we place in authority figures, in statistics or in other patients' stories, in science and technology or in natural healing, whether we seek the most or the least treatment - all are key factors that shape our choices. Recognizing our preferences and the external factors that might lead our thinking astray can make a dramatic, even life-saving, difference in our medical decision-making. When conflicting information pulls us back and forth between options, when we feel pressured by doctors or loved ones to make a particular choice, or when we have no previous experience to guide us through a crisis, Your Medical Mind will prove an essential companion. The authors interviewed scores of patients who have struggled with situations such as these. They also drew on research and insights from doctors, psychologists, economists, and other experts to help reveal the array of forces that can aid or impede our thinking. They show us the subtle strategies drug advertisers use to influence our choices: they unveil the extreme—sometimes dangerously misleading—power of both narratives and statistics. And they help us understand how to improve upon a universal human shortcoming — assessing the future impact of the decisions we make now. Jerome Groopman, a New Yorker writer and bestselling author, is an oncologist who guides his patients through life-or-death decisions. Pamela Hartzband is a noted endocrinologist and educator at Harvard Medical School who helps patients make critical decisions about their long-term health. As patients, the authors have very different preferences, yet they are united when conveying the book's groundbreaking message: we can cut through the confusion and arrive at decisions that serve us best.

Sunday, November 16, 2014

As there is with anything in this life, there are some upsides and some downsides to the Internet-as-doctor approach.

The downsides—as anyone who's ever Googled "sore throat" and emerged several hours later from the virtual rabbit hole convinced of their imminent death can attest—are fairly clear; a simple search can quickly become an experience that haunts the dreams of many a hypochondriac.

Even so, plenty of people regularly turn to the World Wide Web as a first-line medical resource. As Julie Beck has previously noted on this site, 72 percent of Americans have looked online for health information sometime in the past year, while one in three Americans has self-diagnosed a health problem with the help of the Internet. And doctors are following in their patients' footsteps, too: A full 50 percent of physicians turn to Wikipedia for health information, and some are active editors of the site as well.

Doctors are under the microscope. They're scrutinized for their role in our high health-care costs and graded on the quality of their care. Because of cuts in what insurance pays them, their incomes have not kept pace with inflation, creating pressure for practitioners to see more patients. Medical students, burdened by gigantic school debts, are migrating toward the highest-earning specialties and away from lower-paid primary-care fields, where doctors are in short supply.

Educators worry that physicians' stressful training — focused on technology, information and time management — might stunt their ability to gauge patients' emotions and inhibit them from discussing difficult subjects, such as a patient's wishes at the end of life. Most of the beginning medical school students whom I teach are altruistic and caring, but they wonder whether medical school and residency will grind the empathy out of them.

In three remarkable new books, physician-authors illuminate aspects of medicine that members of the profession are often reluctant to talk about: the deeply flawed care of the old and the dying, how greed influences doctors' clinical decisions, and a trainee's searing encounters with patients who are beyond his medical help.